Pain inequality: Differences in pain and how this reflects an unequal healthcare system

Pain inequality: Differences in pain and how this reflects an unequal healthcare system

‘Who handles pain better? Women or men?’ This question circled my biology class at school more than once. Frustrating me, definitely more than once. Today, I am not even going to attempt to answer it. Instead I want to shine a light on the harmful inequality and biases which surround pain even today, focusing on the gender pain bias.

Pain difference based on biological sex is tricky to understand, how can we truly ever know what someone else is going through? Well, sadly we can’t. Although there are some pretty incredible researchers out there attempting to uncover more about pain, I will be focusing my attention to the social side of this issue- how pain is perceived and treated. I am not a health professional, but have based this on verified research with the aim to try and demonstrate how instilled and stretched gender biases are within society.

Recently, pain disparity has come to the forefront of our headlines. The Vagina Mesh scandal revealed thousands of faulty mesh implants were implanted leaving women with chronic pain and life long side effects. The needless suffering experienced by these women and the initial dismissal of these women’s complaints highlighted clearly that women’s pain can be institutionally misunderstood and prompted us to question ‘how can this still be happening?’

So what is the pain gap between men and women?

Firstly, it is important to outline the complexity of this issue. Pain disparity does not refer to just one thing. How our bodies respond and experience pain, how treatment responds to our bodies, how healthcare professional perceive our levels of pain and how we explain our pain levels are all unique factors involved and highlight pain’s multifaceted nature.

What I can tell you is that men and women are treated differently when it comes to pain.

Women in emergency departments who have reported acute pain are less likely to be given opioid painkillers compared to men. On top of this, it will take longer for women to receive them compared to men. Another study revealed that in reference to chronic pain women were more likely to suffer from it, yet more likely to be dismissed. Now is this because women experience less pain? Well, no. In 2011 the Institute of Medicine published a report on chronic pain titled ‘Relieving Pain in America’. It found that women tended to suffer more from pain yet their reports were more likely to be dismissed. How we experience pain is too vast and complex to explore within this article, but I encourage you to have a little research yourself as some of the insights are super interesting!

What causes pain to be treated differently is hard to say. Is it implicit gender bias which is instilled within everyone? Is it assumptions about pain and how they impact women? Is it that pain actually impacts different biological sexes differently?

To start with let’s take a trip through history to make my first point…

Healthcare and medicine is never separate from society. Despite striving for objectivity, science, health and medicine have been socially constructed through time and reflect the ideas, movements and people around it. From antiquity to the so called sexual revolution of the 1960s, medical movements and ideas are constructed on the societal attitudes of the time, they are a part of history and therefore replicate the inequalities within its society. (I hope you are still with me- this is heavy stuff, take a breath)
Classical Greek philosophers such as Aristotle proclaimed the one sex model which presented the female anatomy as an inverted version of males, and thus inferior. Of course, we have come a long way from Aristotle, but the point stands that medicine has been used as a tool throughout history to subordinate groups of people or justify oppression based on societies desires at any one time. Even within the modern period we can see society and culture interconnecting to science. The so called ‘sexual revolution’ of the 1960s and the greater awareness and access to contraception remained reflective of the half-hearted acceptance of the sexually liberated women. Access was provided to married women only, and commonly only married, middle class women. Society and the ruling elites had not fully accepted the sexually active women and therefore healthcare was not too either. The work of activists, movements and oppressed individuals entering the medical sphere however should not be overlooked. They have made great progress to smash through barriers and overcome biases but more work is still to be done. Medicine is intertwined with the societies and culture it belongs in. Where inequality remains, medicine will reflect it.

So how can this explain the pain disparity? The often citied study “The Girl Who Cried Pain: A bias Against Women in the Treatment of Pain” found that women were less likely to receive aggressive treatment and were more likely to for their pain to be characterised as emotional or psychogenic and therefore not as relevant. Now this is relevant to our argument as it can demonstrate how instilled perceptions, stereotypes and assumptions about someone can influence their treatment. Were these women suffering less than their male equivalents? I doubt it. Yet their pain was attributed to emotion. Now this is not harmful for just women, the fact that men’s pain is less likely to be attributed to emotion is dangerous also. Yentl Syndrome also reveals the expectation that women should have to prove their pain is as serious as a man’s to be taken seriously.

The point of reference…

As well as instilled perceptions and stereotypes, the ‘standard’ human being, is male.

The female body is viewed as atypical when it comes to research or points of reference, despite being 50% of the global population. The reference man, used a standard human is usually a white man in his 30s weighing 70kg. Research for example on the prescribed amount of a drug you should take is commonly based on this criterion. Commonly drugs are tested primarily on men leading to unknown consequences for women depsiteit being known that drugs impact the sexes differently due to hormone levels, organ size and body ft composition. Just this year the Food and Drug Administration announced changes to the prescribed dose of Ambien for women.
To me that shows the scale of the problem we are facing here. But what harmful effect does this cause? Well it means that the female body is less understood in general. Leeds University researchers revealed that women are 50% more likely to be misdiagnosed from a heart attack compared to men due to the fact that heart trials typically use male participants.

Now what about actual clinical trials? Well I am sorry to say, these are no better. In 2005 a review of research in the journal of Pain, it was discovered that 79% of pain studies involved only male animals. Now for me there are two issues here, one pain trials for animals (but that is a debate for another day) and two the fact that biological sex seems to have been dismissed.

So back to the attitude towards female pain.

Reproductive female illnesses can demonstrate the lived reality that women’s pain is not taken as seriously as men’s. Worldwide an estimated 1 in 10 menstruators have endometriosis. Despite its prevalence this serious disease takes between 7 and 10 years to diagnose. 7 to 10 years! On top of this, 70% of chronic pain sufferers are women yet 80% of chronic pain study participants are men. Female pain is not recognised for what it is.

As the ‘reference man’ reveals (a white, 30 year old, 70Kg man reveals) there are lots of other factors tied into health inequality other than gender inequality. Race, class, body size to name a few are the other factors at play leading to biases and inequality within medicine. Recently a post went viral outlining the harm caused by the fact that medical textbooks and resources omit black individuals or skin. Conditions such as skin conditions are therefore studied and internalised by medical students using only white skin as reference when the symptoms and signs on black skin may be different. This is another glaring example of the fact that medicine is not equal.

Of course I could go on and on about the pain bias. The biology behind it, the variations across different locations and throughout different cultures. The topic is vast and requires more attention. What I have tried to do today, is shine a light on the reality that pain is viewed differently based on biological sex and this is dangerous. The dismissal of anyone within healthcare can be harmful but when perceptions and procedures become institutional it becomes more dangerous and subtle and thus harder to identify and address. Much more work is still needed to come.